Search Results (111)

Background/Objectives: Since the World Health Organization (WHO) recommended HIV self-testing as an alternative to traditional facility-based testing in 2016, it has been increasingly adopted worldwide. This study aimed to evaluate the performance of the ConfiSign HIV Self-Test (GenBody Inc., Republic of Korea), a newly developed blood-based immunochromatographic assay for the qualitative detection of total antibodies (IgG and IgM) against HIV-1/HIV-2. Methods: The evaluation included four components: (1) retrospective analysis of 1400 archived serum samples (400 HIV-positive and 1000 HIV-negative samples), (2) prospective self-testing by 335 participants (112 HIV-positive participants and 223 individuals with an unknown HIV status, including healthy volunteers), (3) assessment using seroconversion panels and diverse HIV subtypes, and (4) analytical specificity testing for cross-reactivity and interference. The Elecsys HIV combi PT and Alinity I HIV Ag/Ab Combo assays were used as reference assays. Results: In retrospective testing, the ConfiSign HIV Self-Test achieved a positive percent agreement (PPA) of 100%, a negative percent agreement (NPA) of 99.2%, and a Cohen’s kappa value of 0.986, showing excellent agreement with the reference assays. In the prospective study, the test showed 100% sensitivity and specificity, with a low invalid result rate of 1.8%. All HIV-positive samples, including those with low signal-to-cutoff (S/Co) values in the Alinity I assay, were correctly identified. The test also reliably detected early seroconversion samples and accurately identified a broad range of HIV-1 subtypes (A, B, C, D, F, G, CRF01_AE, CRF02_AG, and group O) as well as HIV-2. No cross-reactivity or interference was observed with samples that were positive for hepatitis viruses, cytomegalovirus, Epstein–Barr virus, varicella zoster virus, influenza, HTLV-1, HTLV-2, or malaria. Conclusions: The ConfiSign HIV Self-Test demonstrated excellent sensitivity, specificity, and robustness across diverse clinical samples, supporting its reliability and practicality as a self-testing option for HIV-1/2 antibody detection. Full article

The nicotine metabolite ratio (NMR) has been informative in selecting treatment choices for nicotine dependence and increasing treatment efficacy in Western settings; however, the clinical utility of the NMR among smokers in low-resource settings remains unclear. Prospective analysis was conducted using data from a randomized controlled trial of smoking cessation among adults living with HIV, to examine the association between the NMR and response to smoking cessation treatment. NMR was assessed using bio-banked urine samples collected at baseline. Self-reported smoking at 6 months was verified using a urine cotinine test and exhaled breath carbon monoxide (CO). We found no associations between the NMR and smoking abstinence (adjusted risk ratio (aRR) = 0.82; 95% CI: 0.45, 1.49; p = 0.53). No evidence of effect modification by treatment conditions was observed on the multiplicative scale (aRR = 1.17; 95% CI: 0.32, 4.30; p = 0.81) or additive scale (adjusted relative excess risk due to interaction (aRERI) = 0.10; 95% CI: −1.16, 1.36; p = 0.44). Our results suggest that the NMR may not be a viable approach for selecting smoking cessation treatment in this setting, given the minimal variability in our sample and racial/ethnic makeup of this population. Full article

Cervical cancer continues to be a major global public health problem, with 661,021 estimated new cases and 348,189 deaths reported in 2022. Approximately 53% of women in Jordan reported not being screened for CC in recent years. This study aimed to investigate the determinants associated with not being screened for CC amongst Jordanian women of child-bearing age. This was a cross-sectional study derived from the 2023 Jordanian Demographic Health Survey (JDHS) with 12,580 women aged 15–49 years. The study employed a non-informative Bayesian binary logistic regression approach to identify the factors that are associated with not being screened for CC. Results showed that the prevalence of not being screened for CC was 83.8% (95% CI: 83.3–84.3). The determinants identified in this study were women’s age group (OR = 0.46; 95% CI: 0.34–0.62), education level (OR = 0.56; 95% CI: 0.34–0.91), smoking status (OR = 0.75; 95% CI: 0.63–0.91), women’s nationality (OR = 4.30; 95% CI: 1.03–27.74), breastfeeding status (OR = 1.64; 95% CI: 1.31–2.07), wealth index (OR = 0.61; 95% CI: 0.53–0.71), self-reported health status (OR = 0.74; 95% CI: 0.64–0.87), marital status (OR = 1.45; 95% CI: 1.08–1.96), and HIV testing status (OR = 0.55; 95% CI: 0.40–0.75). The prevalence of not being screened for CC amongst Jordanian women of child-bearing age was found to be very high: a red flag for attention. There is a need for interventions such as community awareness campaigns and education programmes focusing on women younger than 25 years, especially women living in rural and underserved areas. Additionally, incorporating policy interventions into public health facilities and having easy accessibility to tools or screening tests may improve rates of CC screening, and thus reduce the prevalence of CC. Full article

Background/Objectives: High rates of sexually transmitted infections (STIs) increase HIV transmission risk among adolescent girls and young women (AGYW) in South Africa. AGYW prefer discreet self-testing options for HIV and pregnancy; however, other STI self-testing options are currently unavailable in this region. Methods: Seven Chlamydia trachomatis (CT), Neisseria gonorrhea (NG) and Trichomonas vaginalis (TV) assays were validated for AGYW self-test use (using self-collected vaginal samples) in a cross-sectional study (PROVE). Paired GeneXpert^® NG/CT (Cepheid_®, Sunnyvale, CA, USA) and OSOM^® Trichomonas test (Sekisui Diagnostics, Burlington, MA, USA) results from nurse-collected samples served as reference results to calculate sensitivity, specificity, positive predictive values (PPV), and negative predictive values (NPV). One test, the polymerase chain reaction (PCR)-based Visby Medical™ Sexual Health Test device (Visby Medical™, San Jose, CA, USA), was validated for accuracy of positive test results using self-collected samples and home-based testing in a longitudinal follow-up study enrolling AGYW aged 16–18 years. Paired GeneXpert^® NG/CT and TV results from nurse-collected vaginal samples served as reference tests. Results: In PROVE, 146 AGYW contributed 558 paired samples. The Visby Medical™ Sexual Health Test exhibited moderate to high sensitivity (66.7–100%), specificity (80–100%), NPV (66.7–100%), and PPV (66.7–100%) for NG, CT, and TV. The remaining tests’ performances were markedly lower. In the longitudinal study, 28 AGYW contributed 84 paired samples, and the Visby Medical™ Sexual Health Test demonstrated 100% accuracy of positive results for CT, NG, and TV. Conclusions: The Visby Medical™ Sexual Health Test demonstrated high reliability as a potential option for AGYW to discreetly self-test for multiple STIs concurrently. Testing of its acceptability, utility, and feasibility in a larger sample of AGYW is in progress. Full article

Multimorbidity poses significant challenges for resource-constrained healthcare systems, particularly in low and middle income countries where specific combinations of chronic conditions may differentially impact function. This cross-sectional study examined multimorbidity patterns and associations with functioning among 165 adults attending semi-rural primary healthcare facilities in South Africa. Participants completed performance-based measures (handgrip strength, five-times sit-to-stand test, step test and exercise prescription tool [STEP] maximum oxygen consumption) and self-reported function (12-item WHODAS 2.0). Exploratory factor analysis identified three multimorbidity patterns: HIV-hypercholesterolaemia-obesity (Pattern 1), hypertension-anaemia-lung disease (Pattern 2), and stroke-heart disease-hypercholesterolaemia (Pattern 3). Pattern 1 was associated with reduced aerobic capacity (β = −6.41, 95% CI: −9.45, −3.36) and grip strength (β = −0.11, 95% CI: −0.14, −0.07). Pattern 2 showed associations with mild (β = 1.12, 95% CI: 0.28, 1.97) and moderate (β = 1.48, 95% CI: 0.53, 2.43) self-reported functional problems and reduced grip strength (β = −0.05, 95% CI: −0.09, −0.003). Pattern 3 was associated with all self-reported impairment levels, with the strongest association for severe impairment (β = 2.16, 95% CI: 0.32, 4.01). These findings highlight the convergence of infectious and non-communicable diseases in this setting. Simple clinical measures like grip strength and self-reported function may hold potential as screening or monitoring tools in the presence of disease patterns, warranting further research. Full article

Background and Objectives: Romania has the highest rate of cervical cancer in Europe. The aim of this study is to measure the level of sexual health knowledge among participants and determine the extent to which factors such as age, gender, education level, access to sexual health resources, and cultural background influence their knowledge. Materials and Methods: A cross-sectional study was conducted on 1089 Romanian youth participants aged 18–35 years. A self-administered online questionnaire was used concerning the level of knowledge relating to STIs, contraception methods, and preventive attitudes during the 2023–2024 academic year. Results: Most of the participants (93,8%) scored a “good-to-excellent” STI level of knowledge. Despite this, 71.9% of the responders had never taken an HIV test, and 63.5% had never been tested for other STIs. Logistic regression analysis revealed a direct association between higher STI knowledge levels among respondents with age (p < 0.001), underage sexual debuts (p = 0.018), greater parental education (p = 0.016), and those who studied health sciences (p < 0.001). Conclusions: This study highlights the critical need for health communication campaigns to enhance STI knowledge and vaccine literacy to improve the vaccination rates among young people in Romania. The identified knowledge gaps, frequent misconceptions, and barriers to STI testing underscore the importance of comprehensive sexual health education, public health initiatives for reducing the stigma associated with STIs, and improved access to healthcare services for young people. Full article

Voluntary HIV testing and counselling (VCT) in the workplace could reach population groups who may be at risk for HIV but may not readily seek out testing from other services. We conducted a scoping review to understand (a) the nature of evidence related to initiatives and interventions for vocationally active adults on VCT in occupational settings, and (b) any facilitators and barriers to the delivery of and/or engagement with VCT initiatives/interventions in the workplace. JBI scoping review methodology was followed. The protocol was pre-registered. Included studies focused on vocationally active adults (population), VCT interventions or initiatives (concept), and workplaces in any sector or country (context). The review included studies published after 2000, in English, and of any research design. Studies relating to mandatory workplace HIV screening were excluded. MEDLINE, CINAHL, Scopus, PsycINFO, and the Cochrane Central Register of Control Trials were searched. Sources of grey literature included Google Scholar and governmental and organisational websites. One reviewer screened titles and abstracts; a second reviewer independently screened 10%. Data extraction utilised a modified JBI data extraction tool. We identified 17 studies reporting on 12 workplace VCT interventions (20,985 participants, 15–70 years). Studies were conducted in eight countries between 2001 and 2022. Interventions were delivered in organisations of different types, sizes and sectors. Testing included rapid blood tests and oral fluid self-tests. Where reported, the average on-site HIV testing uptake rate was 63%, and the average linkage to care rate was 86.85%. Views of workers, employers and service providers were largely positive. Barriers included being male, masculinity-driven workplace culture, HIV-related stigma, poor knowledge, low risk perceptions, lack of time and low support. Facilitators included on-site testing for convenience and accessibility, rapid and free tests, organisational, managerial and peer support, and embedding HIV tests within general health checks. Evaluation methods varied, although randomised trial designs were uncommon. Despite the limited number of studies, the workplace appears to be a viable route to the delivery of community-based VCT, albeit barriers should be addressed. Reporting quality of interventions and associated evaluations is variable and could be improved with the use of appropriate checklists. Full article

Background: Hepatitis C virus (HCV) infection presents a significant public health challenge globally, particularly in high-burden countries like Nigeria, where an estimated 2.4 million individuals are living with HCV. HCV self-testing (HCVST) can potentially bridge the significant diagnosis gap and help individuals to determine their HCV status in the privacy of their homes. It offers a solution to overcome barriers related to stigma and limited access to healthcare. In Nigeria, Self-testing for hepatitis C has only been implemented in a pilot research context. This study aimed to assess stakeholder and community awareness and perceptions of HCVST in Nigeria. The findings will provide insights that could inform effective policies and future scale-up programs for HCV control. Methods: A cross-sectional descriptive study was conducted using an online social media survey administered through SurveyMonkey. The survey was disseminated across social media platforms and groups between October–November 2023. Participants included Nigerians (both health professionals and non-health professionals) aged 18 years or older residing in any of the 36 states and the Federal Capital Territory (FCT). Data collected include sociodemographic characteristics, awareness and perceptions of HCVST, and perceived benefits and barriers. Results: Of 321 respondents, 94% perceived HCVST as highly important. While 77% of respondents knew about HIVST, only 58% had prior knowledge of HCVST. The analysis also showed that healthcare workers had greater awareness of HIV self-testing (82.3%) compared to non-healthcare workers (50.0%). Most respondents (88%) were highly likely to recommend HCVST and perceived it as a cost-effective alternative to traditional testing. Key perceived benefits included increased disease detection and control (67%), improved access to testing (21%), and reduced stigma (11%). In the unadjusted model, geographical zone (Southern Nigeria: cOR = 0.49, 95% CI: 0.30–0.77, p = 0.002), work experience (more than 20 years: cOR = 2.79, 95% CI: 1.11–8.07, p = 0.039), and prior awareness of HIV self-testing (cOR = 5.24, 95% CI: 3.00–9.43, p < 0.001) were significant predictors of HCVST awareness. However, in the adjusted model, only prior awareness of HIV self-testing remained significant (aOR = 4.77, 95% CI: 2.62–8.94, p < 0.001). Conclusions: The strong support for HCVST among stakeholders in Nigeria highlights its potential to enhance HCV control, especially within the broader context of infectious diseases like STIs. The greater awareness of HIV self-testing among healthcare workers compared to non-healthcare workers indicates the need for targeted awareness campaigns for non-healthcare populations. Addressing these awareness gaps, leveraging lessons from HIVST, and using existing infrastructure will be crucial. Prioritizing public education, outreach, and effective linkage to care will drive the impact of HCVST in achieving HCV elimination goals and position it as a model for expanding similar STI interventions in Nigeria. Full article

Background/Objectives: A late HIV diagnosis represents a significant public health concern in Poland, with approximately 50% of patients being identified as late presenters (LPs), resulting in the delayed initiation of treatment. This study assesses the potential of HIV self-testing (HIVST) to enhance early detection, particularly among heterosexual individuals, and evaluates its advantages and limitations within the Polish context. Methods: This study examines the advantages and disadvantages of HIVST by analyzing data from various studies. It focuses on the acceptability, sensitivity, and specificity of HIVST, comparing blood-based and oral fluid-based tests. Moreover, the economic impact and potential public health benefits of HIVST in Poland are evaluated. Results: HIVST is well-accepted, especially among key populations; it can reduce stigma and enhance privacy. The results of studies conducted in Poland indicate that heterosexuals are more inclined to use self-testing methods than traditional diagnostic procedures. On the other hand, HIVST has the potential for false-negative results due to the serological window and the possibility of missed diagnoses of other sexually transmitted infections (STIs). Moreover, the cost of HIVST remains a significant barrier, as it is not publicly funded in Poland. Conclusions: Despite its limitations, HIVST offers a number of significant benefits, including increased rates of testing and earlier detection, which could prove vital in reducing the transmission of HIV in Poland. This study proposes that increased funding, the integration of HIVST into public health strategies, and further research to enhance its implementation, alongside education and support for its effective use, should be prioritized. Full article

Background/Objective: The aim of this study was to determine the prevalence of high-risk (HR) human papillomavirus (HPV) types by HPV vaccination status and the feasibility of using HPV L1 serology to identify HIV-negative men who have sex with men (MSM) who may be at risk for anal cancer. Methods: This cross-sectional study recruited HIV-negative MSM from a US metropolitan area. The prevalence of HR, quadrivalent, and nonavalent anorectal HPV DNA and HPV L1 serum antibodies was estimated. McNemar’s chi-square and kappa statistics were used to determine significant differences in HPV detection between anorectal DNA swabs and HPV L1 serology. Results: Eighty-two men had adequate anorectal swabs and serology samples for analysis. Men who self-reported receipt of the HPV vaccine (35.6%) had detectable L1 HPV antibodies (93.1%) and a lower prevalence of active anal HPV infections (20.7%) compared to those who reported none. Conclusions: If confirmed in larger prospective studies, a combination of HPV vaccination status or HPV L1 serology and anorectal swabs for HR HPV types could identify HIV-negative MSM who do not need to undergo follow-up anal testing. Full article

Background: Assisted partner services (APS) is a recommended public health approach to promote HIV testing for sexual partners of individuals diagnosed with HIV. We evaluated the cost and cost-effectiveness of integrating oral HIV self-testing (HIVST) into existing APS programs. Methods: Within the APS-HIVST study conducted in western Kenya (2021–2022), we conducted micro-costing, time-and-motion, and provider surveys to determine incremental HIVST distribution cost (2022 USD). Using a decision tree model, we estimated the incremental cost per new diagnosis (ICND) for HIVST incorporated into APS, compared to APS with provider-delivered testing only. Scenario, parameter and probabilistic sensitivity analyses were conducted to explore influential assumptions. Results: The cost per HIVST distributed within APS was USD 8.97, largest component costs were testing supplies (38%) and personnel (30%). Under conditions of a facility-based testing uptake of <91%, or HIVST utilization rates of <27%, HIVST integration into APS is potentially cost-effective. At a willing-to-pay threshold of USD 1000, the net monetary benefit was sensitive to the effectiveness of HIVST in increasing testing rates, phone call rates, HIVST sensitivity, HIV prevalence, cost of HIVST, space allocation at facilities, and personnel time during facility-based testing. In a best-case scenario, the HIVST option was cheaper by USD 3037 and diagnosed 11 more cases (ICND = 265.82). Conclusions: Implementers and policy makers should ensure that HIVST programs are implemented under conditions that guarantee efficiency by focusing on facilities with low uptake for provider-delivered facility-based testing, while deliberately targeting HIVST utilization among the few likely to benefit from remote testing. Additional measures should focus on minimizing costs relating to personnel and testing supplies. Full article

During population-based HIV impact assessments (PHIAs), some participants who self-reported testing HIV-positive (PSRP) tested negative in one or more subsequent survey HIV tests. These unexpected discrepancies between their self-reported results and the survey results draw into question the validity of either the self-reported status or the test results. We analyzed PSRP with negative test results aged 15–59 years old using data collected from 2015 to 2021 in 13 countries, assessing prevalence, self-report status, survey HIV status, viral load, rapid tests and confirmatory tests, and answers to follow-up questions (such as years on treatment). Across these surveys, 19,026 participants were PSRP, and 256 (1.3%) of these were concluded to be HIV-negative after additional survey-based testing and review. PSRP determined to be HIV-negative trended higher in countries with a higher HIV prevalence, but their number was small enough that accepting self-reported HIV-positive status without testing would not have significantly affected the prevalence estimates for HIV or viral load suppression. Additionally, using more detailed information for Uganda, we examined 107 PSRP with any negative test results and found no significant correlation with years on treatment or age. Using these details, we examined support for the possible reasons for these discrepancies beyond misdiagnosis and false reporting. These findings suggest that those conducting surveys would benefit from a nuanced understanding of HIV testing among PSRP to conduct surveys ethically and produce high-quality results. Full article

Background: The number of late diagnoses of HIV remains very high in Poland, leading to a high proportion of patients developing and dying of HIV-related diseases. The main reason for this is the very low utilization of HIV testing. Our analyses aimed to investigate knowledge about the indications for HIV testing among medical university students, as well as identify their own HIV testing experiences. Material and methods: A cross-sectional survey study was designed to collect information on the students’ demographics and their experiences of HIV testing, as well as their knowledge of virus transmission and the indications for testing. Data were collected as part of the HIV_week@WUM project conducted at the Medical University of Warsaw in parallel with the 18th European AIDS Conference, which took place in Warsaw between 18 and 21 October 2023. Results: In total, 545 questionnaires were collected. The median age of the study participants was 20 (interquartile range (IQR): 19–22 years). The majority of respondents were as follows: women (67.5%), born in Poland (97.8%), and were attending the medical faculty (56.7%). Only 114 (21.43%) participants had ever been tested for HIV. For all modes of HIV transmission, most of the respondents overestimated the risk of acquiring HIV, but, at the same time, they had never been tested for HIV. Conclusions: Only one in five health sciences students has ever had a test for HIV, which is less than estimates for the general population of Warsaw. There is an ongoing need to popularize testing among future health care providers in order to address both the indications for testing for individuals and the better use of HIV testing in clinical practice. Full article

Background: Condoms have proven to be an effective contraceptive barrier method of family planning and have played a vital role in preventing sexually transmitted diseases including HIV. However, existing evidence shows that utilization of condoms remains low, especially among youth and adolescents. We aimed to determine the condom use rate and associated factors among the students of Gulu University in Uganda. Methods: A cross-sectional study was conducted among undergraduate students of Gulu University between June and December 2023. The students were accessed from their respective faculties and chosen using a simple random sampling method. Data were collected using a pretested self-administered structured questionnaire. Condom use was defined as use of either male or female condom in any sexual encounter within the previous six months. Results: A total of 404 participants, with a median age of 23 years (interquartile range (21.5–24) years) were enrolled in this study, 54.2% (n = 219) of whom were men. The response rate of the respondents was 94.1%. Overall, 81.4% (n = 329) of the participants were in senior classes (year 2, 3, 4, and 5), and 18.6% (n = 75) were in their first year of study. The condom use rate was 53.7% (n = 217). Condom use rate was 50.2% (n = 109) among male and 49.8% (n = 108) among female students. Sex (men) (aPR = 0.82, 95% CI = 0.71, 0.95, p = 0.01), nature of sexual relationship (married) (aPR = 1.4, 95% CI = 1.07, 1.85, p < 0.015), place of HIV testing (University health unit) (aPR =1.22, 95% CI = 1.06, 1.41, p = 0.005), and having sex in the absence of condoms (aPR = 1.22, 95% CI = 1.01, 1.46, p = 0.021) were significantly associated with consistent condom use. Conclusions: Just over half of undergraduate students of Gulu University used condoms in their sexual encounters in the past six months. There should be heightened campaigns on condom use to prevent unintended pregnancies and sexually transmitted infections. Full article

Men who have sex with men are at an increased risk of acquiring sexually transmitted infections, and although behavioral and contextual interventions have improved, infections continue to spread. Therefore, a new focus on recent trends in sexual health in this population is needed. The aim of this study was to describe the relationship between sociodemographic and behavioral characteristics according to Grindr usage patterns, the prevalence of sexually transmitted infections (STIs), and attitudes toward HIV testing. In January 2020, a cross-sectional study was conducted using a sample of 881 men who have sex with men (MSM) who completed an online questionnaire. We evaluated their Grindr use patterns (moderate or intensive) and explored the associations of these with sociodemographic behavioral characteristics, STIs, and attitudes toward HIV testing. Of 881 participants in total, 587 (66.6%) were intensive Grindr users. Compared to moderate users, these participants reported significantly higher numbers of casual sexual partners (76.2% vs. 23.8%; p < 0.001), were more likely to participate in Chemsex (77.3% vs. 22.7%: p = 0.031), and had a higher self-reported number of STIs (69.9% vs. 30.1; p = 0.046). They also demonstrated better attitudes toward HIV testing (69.7% vs. 30.3%; p = 0.045) and perceived themselves to be at moderate risk of HIV (71.2% vs. 28.8%: p = 0.048). Moreover, intensive Grindr users were 1.36 times more likely than moderate users to test positive for STIs (95%CI = 1.15–1.91; p = 0.048). With some limitations, age, sexual partners, intensive Grindr users, and PrEP uses were associated with the risk of STIs in the sample of Spanish Grindr users studied. As Grindr users are vulnerable to sociodemographic and behavioral factors that determine STIs and HIV infection, mainly among intensive users, it is necessary to highlight the importance of new trends such as online dating apps, PrEP use, substance use in sex, and Chemsex, and these need to be incorporated into online public health strategies. Full article